Treating Veterans with the Respect and Dignity They Deserve

Posted on July 18, 2017.

These days, some veterans struggle to get any medical care at all, let alone the … Read More

Join Dr. Kathleen Hogan for her free and informative seminar today

Posted on June 8, 2017.

The first step towards managing joint pain is understanding it. Join Dr. Kathleen Hogan for … Read More

Dr. Houseman Discusses Surgeries on Man Whose Truck Was Crushed By An 18-Wheeler

Posted on May 16, 2017.

Click here to read about our very own Dr. Bryan K. Houseman in the Union … Read More

New Hampshire Orthopaedic Center

Treating Veterans with the Respect and Dignity They Deserve

Posted on July 18, 2017.

These days, some veterans struggle to get any medical care at all, let alone the quality of care that they need in order to live healthy and productive lives. According to the Boston Globe, 25,000 veterans visit the Manchester VA hospital for outpatient care and surgery each year, and some of them wait months just to see a doctor.

To see if you or a veteran you know is eligible for treatment from New Hampshire Orthopedic Center, call 603.883.0091 today.

Join Dr. Kathleen Hogan for her free and informative seminar today

Posted on June 8, 2017.

The first step towards managing joint pain is understanding it. Join Dr. Kathleen Hogan for her free and informative seminar, “Taking Control of your Joint Pain.” Taking place on Thursday, June 8, 2017 from 2:00 – 3:00 PM, the seminar will cover topics including arthritis of the hip and knee, as well as non-surgical and surgical treatment alternatives.

Space is limited, so call 603-672-5037 or email Cindy@ledgewoodbay.com to register today!

When Can You Go Home After a Hip or Knee Replacement?

Posted on May 30, 2017.

by: Kathleen A. Hogan, MD

When knee and hip replacements were first developed most patients would stay in the hospital for a minimum of a week, sometimes longer. This lengthy hospital stay was felt to be necessary for patients to get the physical therapy and the care they required for a full recovery. Today, this has changed. Most patients do not need to go to a nursing home for further rehabilitation and are able to return directly home after surgery. Most stay only 1-2 nights in the hospital, and some patients can actually go home the day of surgery.

Why is it Necessary to Be in the Hospital After Joint Replacement Surgery?

Certainly if a patient has diabetes, cardiac disease, kidney problems, sleep apnea or COPD it is important to be monitored closely for the first few days after surgery to ensure that there are no medical complications following surgery. But, what about someone without any of these medical problems? Do they need to stay in the hospital just for physical therapy? In the hospital, physical therapists work with joint replacement patients only once or twice a day. This could certainly be done at home.

But What’s Wrong with Staying at the Hospital for a Few Days?

Many people prefer the comforts of home to the sterile conditions of a hospital. While at the hospital, you may be exposed to patients who are sick with the flu or other illnesses. Bacteria found in hospitals is often resistant to many antibiotics. Nurses wake you up to check on you at night and control when you receive medication. Nurses will take care of several patients and may not be available immediately. Most common post-operative problems such as swelling, wound drainage, blood clots can be managed by your surgeon in the office if they occur. Hospital care is also very expensive; hospital and implant costs make up the majority of your bill.

Improved Pain Control Can Reduce Pain With Oral Narcotics

Hip and knee replacements can be painful. Improved pain control with the use of long lasting nerve blocks, multimodal pain management, and intra-articular injections can reduce that pain to a manageable level with oral narcotics. Rotator cuff repair and ACL reconstruction are also painful procedures that used to require a short stay in the hospital but are now outpatient surgeries.

Outpatient Hip and Knee Surgeries at a Surgical Center

Outpatient hip and knee surgeries are performed at a surgical center, not at the hospital. Many patients are ready to go home later that day. They can also stay overnight for observation and go home the next morning. Nurses teach patients how to use crutches or a walker. One nurse is assigned to a maximum of two patients. Physical therapists visit patients at home until they can travel to a therapy office. The surgeon is available for the patient to call if there are any questions or problems at home.

Not Every Patient is a Candidate for Outpatient Hip or Knee Replacement

Not every patient is a candidate for an outpatient hip or knee replacement. However, there is no need for lengthy hospital stays for healthy patients after joint replacement. For carefully selected patients, home Yixing Teapots can be a safer and more comfortable place to recover after surgery than the hospital.

The Quadruple Joint Replacement – Bilateral Hip & Knee Arthroplasty

Posted on April 30, 2017.

by: Kathleen A. Hogan, MD

Hip and knee replacements first began being performed in the United States in the early 1970’s. They are now considered to be one of the most common and most successful orthopedic operations. Over a million joint replacements are performed each year, and it is estimated that over 7 million people in the United States are currently living with artificial hips or knees. This is approximately two percent of the population of this country! The prevalence of joint replacement increases with age. It is estimated that of people over the age of 80, ten percent have had knee replacements and five percent have had hip replacements.

How many people who have arthritis in one hip or knee will have it in the other joint?

Bilateral arthritis is fairly common. This makes sense as the same factors which increase the risk of arthritis (with the exception of injuries) affect both sides equally. For example, a body mass index greater than 35 increases the risk of developing knee arthritis by four and a half times. This should affect both right and left sides equally. One study of patients undergoing joint replacement found an incidence of radiographic arthritis in bilateral joints in over 80 percent of patients.

And, how common is it to have both hips and both knees replaced?

Patients often ask what the odds are of needing to have a second joint replaced. One recent study found that after a hip replacement, almost 30 percent of patients had their contralateral hip replaced within 20 years. After a knee replacement, 45 percent had the contralateral knee replaced. However, the risk of having a hip replacement following a knee replacement (or vice versa) was much lower, only two to six percent.

Why is having both hip and both knees replaced so much less common?

Most people with arthritis in multiple different joints have a systemic cause of their arthritis, such as rheumatoid arthritis (RA). In the past, patients with RA often had severe, crippling deformities with debilitating arthritis of several joints. Joint replacements miraculously restored mobility to patients who were often wheelchair dependent. Many of these patients required both hip and knee replacements. Today, medications have drastically reduced severity of arthritis in patients with RA. It is now somewhat unusual to see severe, untreated rheumatoid arthritis except in third world countries.

Consequentially, it is now also somewhat rare to see a patient who requires replacement of both hips and both knees. Although it has been estimated that eight and a half percent of patients with joint replacements have had at least one hip and one knee replaced, there is no data on the number of patients having both hips and both knees replaced. For those patients who do require quadruple joint replacements, surgery can restore mobility and function and drastically improve the quality of their life.

Tennis and Golf after Joint Replacement

Posted on March 31, 2017.

by: Kathleen A. Hogan, MD

As the last of the snow melts away, our thoughts turn away from the ski slopes and towards the golf course and the tennis courts. Patients who have had their hips or knees replaced frequently ask if they can safely participate in tennis and golf after joint replacement. Make sure you talk to your surgeon about this before resuming an exercise program after surgery as your doctor may have different recommendations for you.

Return to Full Activity

Return to full activity depends on the type of joint replaced and on the patient. Recovery after a hip replacement is typically faster than after knee replacement. The direct anterior approach to hip replacement limits muscle damage and can be particularly beneficial in those looking for a quick return to activities. However, the bone needs to grow into the implant to stabilize it, and many surgeons recommend waiting at minimum 8 weeks before resuming golf or tennis after a hip replacement. Recovery after knee replacement is slower. Time is needed to recover range of motion and gain strength. Most patients need 3-6 months before they can resume vigorous sporting activities.

Will My Artificial Joint Wear Out?

Joint replacements can wear out, and high impact activities such as running may cause the artificial joint to wear out faster, possibly leading to further surgery. Surveys of joint surgeons show a wide variation in recommendations. However, the majority do allow their patients to resume moderate activity, including golf and doubles tennis.

Stress Placed on Knee by Golf and Tennis

Golf and tennis do place considerable stresses on the knee. For example, driving a golf ball generates equivalent joint reactive forces in the knee as does running, just for a much shorter period of time. In golf, the leading knee absorbs the most stress, while in tennis the forehand generates higher joint contact forces in the knee than does the backhand.

How Will My Knee Perform?

How does having a joint replacement affect your athletic performance? It depends. Surveys of small numbers of patients playing golf after joint replacement show that most patients report a small increase in handicap and a decreased drive distance. Most golfers do not walk the course after joint replacement, and instead choose to use a golf cart. Some notice some mild discomfort during and after playing but a high percentage of patients resumed golfing and were playing the same or increased frequency compared to before their surgery. There is limited data on return to play of tennis players. Many patients feel their level of play improves because their joints no longer hurt.

Expectations About Returning to Tennis and Golf after Joint Replacement

One of the goals of hip and knee replacement is to restore mobility and enable patients to get back to activities they enjoy. However, it may take time to rehabilitate your muscles after surgery. Joint replacements are metal and plastic and are not the same as your original parts. Even after joint replacement your new hip or knee may ache or feel stiff after athletic activity. However most golfers and tennis players indicate that they are able to continue to enjoy their sports following joint replacement. Make sure you talk to your surgeon about your expectations of returning to tennis and golf after hip or knee replacement.